HomeMy WebLinkAboutRLC93-00519 - RLC Inspections - 12/20/1993 RESOURCE LANDS AND CRITICAL AREAS CW:C�s=..��' ays),tem
The following checklist is designed to assist an applicant for a Building Permit, On- ewageSite
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Land
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
regulations under the Mason County !nterim Resource Ordinance (77-931*. This checklist is an important
opportunity foridentifying earlyin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner J—►+ho 2 _ Phone #R o(o) 2 75 S 130
Site Address 7114 'TA 4 WA - /,?G Sn,% 1___ Cit af &, g Zip
Owner Address-5 /990 7�lci��� _�tr, City State kzy- Zip9'S'S Z
Tax Parcel No. (Confirm with Assessors Office)-2,Z 3 /_�__ .ra Q 00A6 Legal Description._
eI-7 69. ES psLl y 9 r3,t n 6 '7 _
Projecr. Description__�V �y _ � �eh
Directions to site (Please attach map) &OM �/ -k O✓G., kq �tJ✓vr r�,g�j a4 /fe/�.
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: ease provide or attach a vicinity
lmap
_which includes cross streetr �a3or roads, creeks, etc.
or
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
Official and resource lands are available for review at Mason County Department of Community Development, Planning
Use Only Department. ,, p
Do any of the following exist on this property or within 200 feet of this property?'�/
County Yes No V V
01 ❑ 1. Saltwater shoreline or a lake 20 acres or larger?
❑ ❑ EX 2. Rivers, streams, or creeks with year-rouged flow?
❑ ❑ 3. Rivers, streams or creeks with intermittent flow but are within in a clearly defined channel?
El El4. Lakes or ponds less than 20 acres in size? 'w `l VA
❑ ❑ [ 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.) "
❑ ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) �Q
❑ ❑ ( � o —4-0d/reDderGi&erg7. Floodplains- m ;nt IViaps and County Seismic Hazard Map
for guidance.)
❑ ❑ 8. Seismic Hazard Areas? (See County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.) VW
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
County Yes No
❑ ❑ IX 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ ❑ 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
t RCW'84.34
* Copies aro available at Mason County Department of Community Development for 55.00 each.
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PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location &dimensions of existing &proposed property boundaries. ► Approximate slope of land (grade &direction), topography.
► Identify legal access including,width of all road right-of-ways &easements. ► Location of significant natural features(water bodies, rivers).
► Locate all existing &proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"= North Arrow
I state that 1 have answere the above truthfully to the best of my knowledge.
__ Applicant/Owner 12— 15- 9� Date
FOR OFFICIAL USE ONLY
Adjacent property.
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There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
When completed, this form becomes part of the permit application.
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